PDE-5 Inhibitor Therapy for Erectile Dysfunction Secondary to Nerve-Sparing Radical Retropubic Prostatectomy

The majority of patients receiving therapy for erectile dysfunction (ED) following post-radical retropubic prostatectomy (RRP) are treated with phosphodiesterase (PDE)-5 inhibitors, which seem to have variable efficacy in this population. So far, the only head-to-head trials with PDE-5 inhibitors have been in general ED patients and not in post-RRP patients. Both vardenafil and tadalafil failed to meet statistical noninferiority to sildenafil in head-to-head trials. To date, only sildenafil has demonstrated efficacy in the prevention of post-nerve-sparing RRP ED. The selection of a PDE-5 inhibitor requires consideration of the patient's sexual activity pattern as well as the drug's efficacy and its ability to meet the patient's expectations. In this regard, sildenafil continues to account for almost 70% of PDE-5 inhibitor prescriptions in the United States.